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Letter to the Editor   |    
Psychopharmacologic Calvinism
ROBERT HIERHOLZER, M.D.
Am J Psychiatry 1999;156:1121a-1122.

To the Editor: Poor John Calvin! In two different recent educational audio programs, eminent psychiatrists use Calvin’s name in decidedly pejorative ways. In an audiograph series of the Journal of Clinical Psychiatry(1), Sumer D. Verma, M.D., states that "we have this Calvinistic view about treating pain in the long-term care setting: ‘We must not give them too much analgesia because—you never know—Grandma might become addicted.’" Being fairly sure that Calvin never directly addressed the issue of treating pain with analgesics, I have to speculate about Dr. Verma’s use of "Calvinistic." He seems to suggest that Calvinists are so fearful of the potential evil consequence of analgesia (addiction) that they miss the greater good (pain relief). I do not think he means to imply that Calvinists, with their strong view of God’s sovereignty, find purpose in their suffering and therefore tend to forgo analgesia. Nor does he seem to mean, thankfully, that Calvinists sadistically wish people to suffer. However, he does imply a certain narrow, joyless way of thinking that can be summarized as "what you like isn’t good for you, and what you don’t like is good for you."

This is, in fact, Thomas Gutheil’s definition of "psycho­pharmacologic Calvinism" (2), which he discusses in a lecture distributed on a recent edition of the Audio-Digest tape series. He applies the phrase to patients with borderline personality disorder who tend to desire substances with which they do not improve (alcohol, street drugs, and benzodiazepines) and improve with drugs that they do not like (lithium, monoamine oxidase inhibitors, phenothiazines). Like Verma, Gutheil posits denial as central to Calvinism. Unlike Verma, Gutheil suggests that this form of Calvinism—psychopharmacologic Calvinism—is, in fact, good psychiatric practice, whereas Verma’s "analgesic Calvinism" is denounced as inappropriate.

Seemingly, these two psychiatrists are ascribing to Calvin incompatible views. However, in both formulations, the emphasis is on the patient’s perspective—namely, the denial of that which is desired. Despite Gutheil’s endorsement of the clinical practice, he jokingly invokes Calvin’s name to label a way of thinking in which people’s desires are ignored—namely, a rigid, mindless, killjoy denial. Thus, despite superficial appearances, these views reflect a similar view of Calvinism as a grim theology.

A brief examination of Calvin’s thoughts may help paint a more accurate picture of his theology. Calvin certainly does enjoin Christians to face "all the accidents to which this present life is liable," whether disease, pestilence, or the calamities of war, "with patience and endurance" (3). This attitude is to be rooted in an understanding of God as the "ruler and arbiter of the fortunes of all" (3). While the individual is enjoined to adopt this attitude toward his own situation, the Christian’s attitude toward others is to be characterized by a charity derived from the recognition that man "is distinguished by the lustre of his [God’s] own image" (3). This recognition, Calvin asserts, should lead Christians to "put themselves in the place of him whom they see in need of their assistance," which should then "incline him to assist him" (3). Further, Calvin condemns excessive austerity characterized by the belief that "earthly blessings" are to be used only for necessities and not for pleasure (3). Such a view, he contends, "not only maliciously deprives us of the lawful fruit of the divine beneficence, but cannot be realized without depriving man of all his senses, and reducing him to a block" (3).

While Calvin admonishes believers not to curse God for their present misfortunes, he does not advocate ignoring the suffering of others. Nor does he commend a joyless, grim life in which suffering is pursued. When psychiatrists such as Gutheil and Verma use "Calvinistic" in the erroneously simplistic manner cited previously, they do not do justice to the richness of Calvin’s theology. Sadly, this use seems to reflect American psychiatry’s ignorance of theology and its import. This ignorance can only further exacerbate the wariness and skepticism toward psychiatry felt by many people of faith.

Verma SD: The routine use of atypical antipsychotic agents in the treatment of geriatric patients. J Clin Psychiatry Audiograph Series 1998; 1(2)
 
Gutheil TG: Liability in psychopharmacology: minimizing risks. Audio-Digest Psychiatry 1998; 27(10)
 
Calvin J: Institutes of the Christian Religion. Translated by Beveridge H. Grand Rapids, Mich, William B Eerdmans, 1975
 
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References

Verma SD: The routine use of atypical antipsychotic agents in the treatment of geriatric patients. J Clin Psychiatry Audiograph Series 1998; 1(2)
 
Gutheil TG: Liability in psychopharmacology: minimizing risks. Audio-Digest Psychiatry 1998; 27(10)
 
Calvin J: Institutes of the Christian Religion. Translated by Beveridge H. Grand Rapids, Mich, William B Eerdmans, 1975
 
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